Endocardial lead removing apparatus

Abstract

The invention provides an apparatus having a tubular member for receiving an endocardial lead implanted within a patient's body. Disposed generally at a distal end of the tubular member is at least one blade or cutting surface. An adjustment mechanism moves the blade between retracted and extended positions to engage the cutting surface with the endocardial lead to cut the lead. Once severed, the cut portion of the lead remains within an inner channel of the tubular member and the apparatus and cut portion of the lead are removed from within the patient. Various embodiments include the blade pivotally connected to the distal end of the tubular member and activated by a wire adjustment mechanism. Others include a metallic wire for slicing through the lead. Still others include a pneumatically actuated adjustment mechanism that inflates to move the blade and engage the cutting surface with the lead.

Description

FIELD OF THE INVENTION[0001]This invention relates generally to an endocardial lead removing apparatus and, more particularly, to an apparatus that cuts the endocardial lead and, in some embodiments, captures the cut portion to remove the lead from the patient's body.BACKGROUND OF THE INVENTION[0002]In the past, various types of endocardial leads and electrodes have been introduced into different chambers of a patient's heart, including among other locations, the right ventricle, right atrial appendage, and atrium, as well as the coronary sinus. These flexible leads are often composed of an insulator sleeve that contains an implanted helical coil conductor that is attached to an electrode tip. This electrode is placed in contact with myocardial tissue by passage through a venous access, often the subclavian vein or one of its tributaries, which leads to the endocardial surface of the heart chambers. The tip with the electrode contact is held in place by trabeculations of myocardial ...

AI Technical Summary

Benefits of technology

Minimizes the risk of complications by allowing for the safe extraction of endocardial leads, reducing the likelihood of disrupting myocardial tissue or causing emboli during removal.

Problems solved by technology

Although the state of the art in implemented pulse generator or pacemaker technology and endocardial lead technology has advanced considerably, endocardial leads nevertheless occasionally fail, due to a variety of reasons, including breakage of a lead, insulation breaks, breakage of the inner helical coil conductor and an increase in electrode resistance.

Although it obviously would be desirable to easily remove such unused leads, in the past surgeons usually have avoided attempts to remove inoperative leads because the risk of removing them exceeded the risk of leaving them in.

The risks of leaving unused myocardial leads in the heart and venous path include increased likelihood that an old lead may facilitate infection, which in turn may necessitate removal of the lead to prevent continued bacteremia and abcess formation.

Furthermore, there is an increased likelihood of the formation of blood clots in the atrial chamber about entangled leads.

Such clots may embolize to the lung and produce severe complications and even fatality.

Furthermore, the presence of unused leads in the venous pathway and inside the heart can cause considerable difficulty in the positioning and attachment of new endocardial leads in or to the heart.

Even then, it is possible that a clot has formed so the removal of the leads causes various sized emboli to pass to the lungs, producing severe complications.

In cases where the lead tip has become attached by scar tissue to the myocardial wall, removal of the lead always has presented problems and risks.

Sufficient traction on such leads in a removal attempt could cause disruption of the myocardial wall prior to release of the embedded lead tip.

The tines or flanges of other types of leads that are not tightly scarred to the myocardial wall present similar risks.

Continual strong pulling or twisting of the outer free end of the lead could cause rupture of the atrial wall or the ventricular wall if there is such tight circumferential encasement of adherent channel scar tissue in the venous path.

The risks of removing the lead by such traction and rotation of the lead may be high enough so that, if it becomes imperative that the lead be removed (as in the case of infection), many surgeons have elected to open the patient's chest and surgically remove the lead rather than attempt removal by applying traction and rotation thereto.

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